维持性血液透析患者残余尿量与其透析质量的相关性-东南大学学报医学版

维持性血液透析患者残余尿量与其透析质量的相关性

单位：广东省人民医院肾内科暨血液净化中心, 广东广州 510080

分类号：R459.5

出版年·卷·期（页码）：2014·33·第四期（406-410）

摘要：

目的：调查广东省人民医院肾内科暨血液净化中心维持性血液透析患者的残余尿量情况，并分析残余尿量与透析质量的相关性。方法：记录2012年3月在广东省人民医院血液净化中心行维持性血液透析超过3个月患者的残余尿量，并收集患者临床和实验室资料，分析患者残余尿量与透析质量的相关性。定义尿量<100 ml·（24 h）^-1为无尿，100~400 ml·（24 h）^-1为少尿，>400 ml·（24 h）^-1为尿量正常。结果：共384例患者纳入本研究，男女比例为194：190。其中无尿者179例，少尿患者98例，尿量正常者107例。有尿患者的年龄、干体重、血压、尿素氮下降率、Kt/V、血白蛋白及血红蛋白水平与无尿患者比较，差异无统计学意义，但有尿患者透析龄较短[（27.49±23.54）个月vs（58.38±44.37）个月，P<0.001）]，血清钾[（5.01±0.86）mmol·L^-1vs（5.21±1.01）mmol·L^-1]，P=0.037]、钙[（2.16±0.25）mmol·L^-1vs（2.26±0.31）mmol·L^-1，P=0.001]、磷[（1.97±0.66）mmol·L^-1vs（2.12±0.64）mmol·L^-1，P=0.018]、甲状旁腺素[（283.65±382.81）pg·L^-1vs（459.98±610.91）pg·L^-1，P=0.001]、碱性磷酸酶[（75.71±66.51）U·L^-1vs（121.60±219.75）U·L^-1，P=0.01]、肌酐[（884.66±263.81）mol·L^-1vs（1 027.90±277.51）mol·L^-1，P<0.001]、β₂微球蛋白[（35.02±11.81）mg·L^-1vs（44.52±13.23）mg·L^-1，P<0.001]水平明显较低。尿量正常的患者与少尿者比较，透析龄更短[（34.42±27.29）个月vs（20.98±17.12）个月，P<0.01]，血肌酐[（925.90±232.63）μmol·L^-1vs（847.66±284.95）μmol·L^-1，P<0.01]、β₂微球蛋白[（39.77±11.33）mg·L^-1vs（30.76±10.57）mg·L^-1，P<0.01）水平明显低。结论:维持性血液透析患者的残余尿量随着透析时间的延长逐渐减少，透前血钾及甲状旁腺素水平低，中分子毒素清除较好。保护患者的残余尿量有重要意义。

To research residual urine volume and the correlation between residual urine volume and the dialysis quality in hemodialysis patients in our center. Methods: Residual urine volume of maintenance hemodialysis patients over three months were record in March 2012 at the Guangdong Provincial People's Hospital. Clinical and biochemical parameters were collected and correlation between residual urine volume and dialysis quality were analyzed. Residual daily urine volume less than 100 ml·(24 h)^-1 was defined as anuria,daily urine volume 100-400 ml·(24 h)^-1 and more than 400 ml·(24 h)^-1 were defined as oliguria and normal urine volume respectively. Results: Three hundred eighty-four patients were collected and male and female ratio was 194 :190. Among them,179 patients were anuria,98 patients were oliguria and 107 patients had the normal urine volume. Compared with the anuria patients,the patients with residual daily urine volume had shorter dialysis time[(27.49±23.54) months vs(58.38±44.37) months,P<0.001)] and lower potassium[(5.01±0.86) mmol·L^-1 vs(5.21±1.01) mmol·L^-1,P=0.037)], calcium[(2.16±0.25) mmol·L^-1 vs(2.26±0.31) mmol·L^-1,P=0.001), phosphate[(1.97±0.66) mmol·L^-1 vs(2.12±0.64) mmol·L^-1,P=0.018), intact parathyroid hormone[(283.65±382.81) pg·L^-1 vs(459.98±610.91) pg·L^-1,P=0.001), alkaline phosphatase (ALP)[(75.71±66.51) U·L^-1 vs(121.60±219.75) U·L^-1,P=0.01), creatinine[(884.66±263.81) μmol·L^-1 vs(1 027.90±277.51) μmol·L^-1,P<0.001], β₂-microglobulin level[(35.02±11.81) mg·L^-1 vs(44.52±13.23) mg·L^-1,P<0.001] level. Compared with oliguria group, patients with normal urine volume had shorter dialysis time[(34.42±27.29) months vs(20.98±17.12) months,P<0.01], and even lower creatinine[(925.90±232.63) μmol·L^-1 vs(847.66±284.95) μmol·L^-1,P<0.01] and β₂-microglobulin level[(39.77±11.33) mg·L^-1 vs(30.76±10.57) mg·L^-1,P<0.01]. Conclusion: The residual daily urine volume are reduced as dialysis time prolonging. But patients who have residual daily urine volume have better potassium, intact parathyroid hormones and β₂-microglobulin control.

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